Healthcare Provider Details

I. General information

NPI: 1942537121
Provider Name (Legal Business Name): CARON LYNN CUNNINGHAM HULSEY CTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2009
Last Update Date: 11/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1618 EXCELSIOR RD
GREENWOOD AR
72936-5106
US

IV. Provider business mailing address

1618 EXCELSIOR RD
GREENWOOD AR
72936-5106
US

V. Phone/Fax

Practice location:
  • Phone: 479-597-0022
  • Fax: 479-314-1708
Mailing address:
  • Phone: 479-597-0022
  • Fax: 479-314-1708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number2008137
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: